Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity
Open accessAbstract
Importance: Although the American Academy of Pediatrics has recommended treatment with antiobesity drugs for adolescents, the cost-effectiveness of antiobesity drugs for this population is still unknown. Objective: To quantify cost-effectiveness of different antiobesity drugs available for pediatric use. Design, Setting, and Participants: This economic evaluation used a Markov microsimulation model with health states defined by obesity levels. Effectiveness was measured by quality-adjusted life-years (QALYs) and costs were calculated from third-party payer perspective, estimated in 2023 US dollars over a 10-year horizon. Data were obtained from the published literature. Intervention: Antiobesity drugs orlistat, liraglutide, semaglutide, and phentermine-topiramate vs no treatment. Metformin hydrochloride and 2 types of bariatric surgical procedures (sleeve gastrectomy and gastric bypass) were considered in sensitivity analysis. Main Outcomes and Measures: Incremental cost-effectiveness ratio. Results: Among the 4 antiobesity drugs currently approved for pediatric use, phentermine-topiramate was the most cost-effective with an incremental cost-effectiveness ratio of $93 620 per QALY relative to no treatment in this simulated cohort of 10 000 adolescents aged 12 to 17 years (mode, 15 years) with severe obesity (62% female). While semaglutide offered more QALYs than phentermine-topiramate, its higher cost resulted in an incremental cost-effectiveness ratio ($1 079 480/QALY) that exceeded the commonly used willingness-to-pay threshold of $100 000 to $150 000/QALY. Orlistat and liraglutide cost more and were less effective than phentermine-topiramate and semaglutide, respectively. Sleeve gastrectomy and gastric bypass were more effective than phentermine-topiramate but were also more costly, rendering them not cost-effective compared with phentermine-topiramate at the willingness-to-pay threshold of $100 000 to $150 000/QALY. Conclusions and Relevance: In this economic evaluation of weight loss drugs for adolescents with severe obesity, we found phentermine-topiramate to be a cost-effective treatment at a willingness-to-pay threshold of $100 000 to $150 000/QALY. Further research is needed to determine long-term drug efficacy and how long adolescents continue treatment.
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For adolescents with severe obesity and comorbidities, pharmacological treatment with phentermine/topiramate ER is cost-effective.
“Adolescents with severe obesity (≥ 120% of the 95th percentile) and comorbidities such as prediabetes, PCOS, or MAFLD may benefit from pharmacotherapy and for them the pharmacological treatment in particular with Phentermine/Topiramate ER is cost effective [110, 111].”
From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [111]
The Conclusions report that phentermine-topiramate was cost-effective for adolescents with severe obesity. The Methods (Study Cohort and Model Structure) define the modeled group by age and BMI, not by comorbidities; the paper does not establish cost-effectiveness specifically for adolescents with prediabetes, PCOS, or MAFLD. (LLM, conf=0.87)
Experimental — accuracy not yet measuredAdolescents with severe obesity (≥120% of the 95th percentile) and comorbidities such as prediabetes, PCOS, or MAFLD may benefit from pharmacotherapy.
“Adolescents with severe obesity (≥ 120% of the 95th percentile) and comorbidities such as prediabetes, PCOS, or MAFLD may benefit from pharmacotherapy and for them the pharmacological treatment in particular with Phentermine/Topiramate ER is cost effective [110, 111].”
From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [111]
The Methods (Study Cohort and Model Structure; page unavailable) define the modeled population as adolescents with severe obesity, and the Conclusions (page unavailable) find phentermine-topiramate cost-effective for that population. The paper does not establish a benefit specifically for adolescents with prediabetes, PCOS, or MAFLD; those comorbidities were not criteria for the modeled cohort. (LLM, conf=0.88)
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- Authors
- Mital, S., & Nguyen, H. V.
- Affiliations
- University of Manitoba (CA)
- Memorial University of Newfoundland (CA)
- Corresponding author
- Nguyen, Hai V.
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2023-10-12
- Volume
- 6
- Issue
- 10
- Pages
- e2336400
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC10570871
- OpenAlex
- W4387563231
- Cited by
- 41
- References
- 32
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 9 · 2023: 2
- FWCI
- 6.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- JAMA Network Open (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- anti-obesity drugs, adolescent obesity, morbid obesity, cost-effectiveness, phentermine/topiramate, semaglutide, liraglutide, orlistat, sleeve gastrectomy, gastric bypass, bariatric surgery, metformin, quality-adjusted life years, Markov microsimulation model, willingness-to-pay threshold
- MeSH terms
- Liraglutide, Topiramate, Orlistat, Adolescent, Child, Cost-Benefit Analysis, Female, Humans, Male, Obesity, Obesity, Morbid, Phentermine, Anti-Obesity Agents
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